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General NPI Number Information
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NPI Number | 1033825302
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Entity Type | Individual
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Provider Name | ANDREJ CHRISTOPHER PETERKA LAC
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Gender | Male
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 313 3RD AVE
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City | WHALAN
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State | MN
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Zip | 55949-8019
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Country | US
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Telephone | 612-532-1058
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Fax |
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Provider Business Mailing Address
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Address Line | 313 3RD AVE
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City | WHALAN
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State | MN
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Zip | 55949-8019
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Country | US
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Telephone | 612-532-1058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1052
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License Number State | MN
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